多黏菌素 B 免疫吸附柱直接血液灌流对需要肾脏支持的危重症患者中美罗培南的影响。

The effect of direct hemoperfusion with polymyxin B immobilized cartridge on meropenem in critically ill patients requiring renal support.

机构信息

Department of Pharmacy Practice, Faculty of Pharmaceutical Science, Chulalongkorn University, Bangkok 10330, Thailand; Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand.

Department of Pharmacy Practice, Faculty of Pharmaceutical Science, Chulalongkorn University, Bangkok 10330, Thailand.

出版信息

J Crit Care. 2019 Jun;51:71-76. doi: 10.1016/j.jcrc.2019.02.007. Epub 2019 Feb 5.

DOI:10.1016/j.jcrc.2019.02.007

PMID:30769293

Abstract

PURPOSE

To evaluate the effect of direct hemoperfusion with polymyxin B immobilized cartridge (DHP-PMX) on meropenem pharmacokinetics in critically ill patients with sepsis requiring continuous venovenous hemofiltration (CVVH).

MATERIAL AND METHODS

After intravenous infusion of 1 g meropenem over 3 h repeated every 8 h for at least 3 doses, 2 serial blood and ultrafiltration fluid samples were collected: one over a dose interval of meropenem with DHP-PMX therapy; and the other on the following day over a dose interval of meropenem with no DHP-PMX therapy. Meropenem concentrations were measured by high performance liquid chromatography. Pharmacokinetic parameters of meropenem and extraction ratio of DHP-PMX were calculated.

RESULTS

Mean AUC of meropenem on DHP-PMX day was comparable to that of the DHP-PMX free day (285.2 ± 138.2 vs 297.8 ± 130.2 mg ∗ h/L; paired t-test, p = .618). No statistical significance of peak and trough concentrations, volume of distribution, sieving coefficient, or half-life were found. Extraction ratio of DHP-PMX on meropenem was 0 [0-0.03] and clearance by DHP-PMX was 0.04 [0-0.2] L/h which was not considered clinically significant.

CONCLUSIONS

No significant effect of DHP-PMX on meropenem pharmacokinetics was observed among severe sepsis/septic shock patients during CVVH treatment.

TRIAL REGISTRATION

Clinical Trial Registry detail: NCT registry: 02413541 (First registered March 3, 2015, last update October 16, 2017).

摘要

目的

评估在需要连续静脉-静脉血液滤过（CVVH）的脓毒症危重症患者中，使用聚砜固定多粘菌素 B 吸附柱（DHP-PMX）进行直接血液灌流对美罗培南药代动力学的影响。

材料与方法

在至少 3 个剂量的静脉输注美罗培南 1 g，每 8 小时 1 次，输注 3 小时后，收集 2 份血样和超滤液样本：1 份是在使用 DHP-PMX 治疗的美罗培南剂量间隔内采集的；另 1 份是在次日没有使用 DHP-PMX 治疗的美罗培南剂量间隔内采集的。采用高效液相色谱法测定美罗培南的浓度。计算美罗培南的药代动力学参数和 DHP-PMX 的提取率。

结果

DHP-PMX 日的美罗培南 AUC 与 DHP-PMX 自由日的 AUC 相当（285.2±138.2 与 297.8±130.2 mg·h/L；配对 t 检验，p=0.618）。未发现峰浓度、谷浓度、分布容积、筛系数或半衰期有统计学差异。DHP-PMX 对美罗培南的提取率为 0 [0-0.03]，DHP-PMX 的清除率为 0.04 [0-0.2] L/h，无临床意义。